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Resume L’imagerie du cancer du sein a beaucoup evolue au cours des 20 dernieres annees en profitant du developpement incessant de l’informatique. De nouvelles solutions techniques en mammographie (tomosynthese-angiomammographie), en echographie (elastographie, echographie automatisee) et en IRM (diffusion, protocole court) mais egalement en medecine nucleaire vont possiblement remplacer nos outils actuels. Mais la veritable revolution a venir sera certainement l’utilisation des enormes volumes de donnees numeriques actuellement inexploitees dans le cadre des solutions apportees par les techniques d’intelligence artificielle (aide a l’interpretation, radiomiques) ou alors des progres des techniques de biologie (genomique, proteomique) qui permettront de proposer une imagerie veritablement personnalisee aux femmes.

High-risk neuroblastoma is characterized by poor long-term survival, especially for very high-risk (VHR) patients (poor response of metastases after induction therapy). The benefits of a tandem high-dose therapy and hematologic stem cell reinfusion (HSCR) have been shown in these patients. Further dose escalation will be limited by toxicity. It is thus important to evaluate the efficacy and tolerability of the addition of new agents such as I-MIBG (131Iode metaiodobenzylguanidine) to be combined with high-dose therapy in the consolidation phase. We report the feasibility of busulfan/melphalan (BuMel) after I-MIBG therapy with HSCR in patients with refractory or relapsed metastatic neuroblastoma. From November 2008 to March 2015, 9 patients received BuMel after I-MIBG therapy and topotecan. The main toxicity was digestive with only 1 patient developing grade 4 sinusoidal obstructive syndrome. Seven patients are alive at a median follow-up of 25 months. Among them, 2 are in ongoing complete remission and 1 in ongoing stable disease. These results suggest that BuMel with HSCR can be administered safely 2 months after I-MIBG therapy associated with topotecan for VHR patients. This strategy will be compared with tandem high-dose chemotherapy (thiotepa and busulfan-melphalan), followed by HSCR in the upcoming SIOPEN VHR Neuroblastoma Protocol.

The purpose of this study is to assess the efficacy of 153Sm-EDTMP (Quadramet®) in a clinical setting. We have conducted a retrospective study of all consecutive patients (pts) treated with 153Sm-EDTMP for painful bone metastases. At each visit (before and after treatment), four parameters were collected: (i) pain assessment according to the 10-step visual analogue scale (VAS), (ii) sleep disturbance related to pain, (iii) dose of analgesic medication, and (iv) answer to the following closed question “Do you think you obtained a benefit from treatment?” Success of treatment was defined by the combination of these four parameters. Three hundred seventy consecutive 153Sm-EDTMP treatments for painful bone metastases were given. Patients had the following primary tumors: breast carcinoma (153), prostate carcinoma (155), lung carcinoma (27), or other cancers (35). Fifty-eight percent of the patients had received previous external osseous radiotherapy. Ninety-seven percent of the patients were treated with concomitant analgesics and 61% were treated with diphosphonates. A clinical benefit was described in 55.0% of cases at D30. Treatment was more effective in cases of breast and prostate cancers compared with other types of primary cancers. Patients described a benefit at D30 in 62, 58, 6, and 38% of cases of breast, prostate, lung, and other cancers. The subjective efficacy was accompanied by a decrease in analgesic intake in 35.0% of cases. 153Sm-EDTMP therapy is an effective supportive treatment in patients who suffer from bone metastases, especially in patients with breast or prostate cancer.

Breast cancer imaging is always improving for the last 20 years in spite of digitalization and computer development. News tools in mammography (Digital Breast Tomosynthesis, Contrast enhanced mammography), sonography (elastography, Automated echography), MRI (Diffusion, abbreviated MRI) and Nuclear medicine has the great potential to be the future of breats imaging. But true revolution will be to use the huge volume of "hidden" imaging data, by Intelligence Artificial process or Biological progress (in genomics, proteiomics) to purpose to our patient a personalized imaging.

Malignant struma ovarii (SO) is a rare tumor, and as a consequence, treatments and follow-up procedures are not clearly established. Presented in this study are two cases of suspicious ovarian masses, resected and corresponding to malignant SO on histopathology. Similar to thyroid cancer, we proposed complementary radioiodine therapy (131I) after total thyroidectomy (no malignancy was observed at this level in our two patients). Patients underwent treatment with 3.7 GBq 131I followed by post-therapy whole-body scintigraphy, which can detect residual disease or occult metastases. Thyroid remnant ablation increases the sensitivity and specificity of follow-up testing using serum thyroglobulin levels as a tumor marker. Our two patients remained disease-free for 3 and 5 years, respectively, after treatment., Highlights • Malignant struma ovarii is a rare ovarian tumor, corresponding to thyroid carcinoma. • It is generally diagnosed after surgical resection of an ovarian mass. • Iodine 131 therapy can be proposed for adjuvant therapy, after total thyroidectomy. • Follow-up must be extended for 20 years, using thyroglobulin level as a tumor marker.

Stereotactic body radiation therapy is the standard treatment for inoperable patients with early-stage lung cancer. Local control rates range from 80 to 90 % 2 years after treatment. The role of positron emission tomography in patient selection is well known, but its use for target definition or therapeutic response evaluation is less clear. We reviewed the literature in order to assess the current state of knowledge in this area.

Resume Objectifs Le but de cette etude etait d’evaluer retrospectivement l’impact de la tomographie d’emission de positons couplee a la tomodensitometrie (TEP/TDM) au 18 F-fluoro-desoxy-glucose (FDG), comparee au bilan conventionnel d’imagerie (BCI), dans le bilan initial et l’evaluation precoce de la reponse therapeutique des rhabdomyosarcomes de l’enfant. Patients et methode Avant traitement, une TEP/TDM a ete realisee en complement du BCI (IRM du site tumoral initial, TDM thoraco-abdomino-pelvienne et scintigraphie osseuse) chez 18 enfants, âges de neuf mois a 17 ans, porteurs d’un rhabdomyosarcome prouve histologiquement. Apres trois cures de chimiotherapie, 12 patients ont beneficie d’une TEP/TDM en complement du BCI. Les criteres RECIST et une analyse visuelle des variations de l’intensite de captation du FDG etaient utilises pour l’evaluation de la reponse therapeutique. Le standard de reference (Gold Standard) etait determine par consensus d’experts lors d’une reunion de concertation multidisciplinaire basee sur les resultats d’imagerie, l’histologie, les donnees du suivi (mediane = 5 ans). Resultats La sensibilite de la TEP/TDM etait superieure a celle du BCI dans l’evaluation des statuts ganglionnaire (respectivement, 100 % et 83 %) et metastatique (respectivement, 100 % et 50 %). Les resultats de la TEP/TDM modifiaient la prise en charge therapeutique pour 11 % des cas. Apres trois cures, la TEP/TDM retrouvait 66 % de reponse complete versus 8 % pour le BCI, le taux de recidive etait de 5 % sur une duree de suivi mediane de cinq ans. Conclusion Cette etude confirme que la TEP/TDM apporte d’importantes informations additionnelles dans le staging initial des rhabdomyosarcomes et suggere une valeur pronostique superieure de la TEP/TDM dans l’evaluation precoce de la reponse therapeutique.

Introduction L’analyse de texture suscite un interet grandissant en oncologie. Il n’existe cependant que peu de donnees concernant le cancer du sein. Nous avons donc etudie les liens entre les donnees de l’analyse de texture en TEP/TDM au 18F-FDG et les criteres anatomopathologiques etablis sur piece de mastectomie. Materiel et methodes Cent-deux patientes ayant effectue une TEP/TDM au 18F-FDG au cours de leur bilan initial pre-chirurgical de cancer du sein ont ete retrospectivement incluses. L’effectif comportait 97 carcinomes canalaires infiltrants (CCI) et 20 carcinomes lobulaires infiltrants (CLI). Etaient recueillis pour chaque lesion : la Standardized Uptake Value (SUV)max, le volume tumoral metabolique (MTV), le taux de glycolyse totale (TLG) ainsi que 7 parametres de texture : l’homogeneite, l’entropie, le High Grey-level Run Emphasis (HGRE), le Short-Run Emphasis (SRE), le Long-Run Emphasis (LRE), le High Grey-level Zone Emphasis (HGZE) et le Low Grey-level Zone Emphasis (LGZE). Une regression univariee etait utilisee pour identifier l’association entre les parametres TEP (usuels et de texture) et les criteres anatomopathologiques de la piece operatoire : type histologique, recepteurs aux estrogenes (RE), statut HER2, grade histopronostique (GHP) et presence d’emboles vasculaires (EV). La comparaison des parametres TEP au type histologique a ete effectuee sur l’effectif total, le reste des analyses a ete effectue sur le groupe des 97 CCI. Resultats L’homogeneite etait plus basse pour les lesions de GHP 3 (OR : 0,538 [0,368–0,786] ; p = 0,001) ou HER2+++ (OR : 0,517 [0,297–0,901] ; p = 0,02) et plus elevee pour les CLI (OR : 2,14 [1,508–3,039] ; p

The aim of this retrospective study was to evaluate the contribution of (18)F-FDG PET to the clinical management and survival outcome of patients suspected of recurrent cervical carcinoma and in line with the hypothesis that early diagnosis of recurrent cervical cancer may improve overall survival.A total of 40 patients underwent conventional imaging (CI) and FDG PET/CT for suspected cervical cancer. Clinical management decisions were recorded with CI and additional PET/CT. Discordances and concordances between CI and PET/CT results were compared to the final diagnosis as based on histopathology analysis or follow-up considered as the gold standard.The final diagnosis was established pathologically (n = 25) or by median clinical follow-up for 48 months after the PET (n = 15). The PET/CT was positive in 76% (20/26) of patients compared to 19% (6/26) with CI. Globally PET/CT modified the treatment plan in 55% (22/40) of patients and in 75% (18/24) when the CI was negative prior to PET/CT. These changes led to the use of previously unplanned therapeutic procedures in 37.5% (15/40). When FDG PET was positive for recurrence (3 foci), the median overall survival was 12 months (2-70) compared to patients with PET findings withor = 1 focus for which the median survival was not attained (p = 0.007). A multivariate analysis of prognostic factors demonstrated that abnormal FDG uptake (3 foci) was the most significant factor (p0.03) for death from cervical cancer.FDG PET is a valuable tool in the case of suspected recurrence of cervical cancer on account of its impact on treatment planning and especially in predicting patient outcome.

Resume La radio-immunotherapie (RIT) est une forme de radiotherapie interne utilisant comme agent de vectorisation un anticorps monoclonal, reconnaissant un antigene exprime par les cellules tumorales, couple a un radionucleide. Developpee depuis plus de 20 ans, son efficacite est demontree en hematologie dans le traitement du lymphome B. L’anticorps monoclonal murin anti-CD20 marque a l’yttrium-90 (Zevalin ® ) peut etre utilise en routine clinique dans le traitement des lymphomes folliculaires CD20 positifs chez les adultes refractaires ou rechutant apres traitement par rituximab, conduisant a des taux de reponse de l’ordre de 70 a 80 % avec 20 a 30 % de reponse complete (RC). L’efficacite de la RIT du lymphome est plus importante en premiere ligne therapeutique, en consolidation apres un traitement par chimio-immunotherapie ou dans le cadre de protocoles myeloablatifs. Des resultats interessants ont egalement ete obtenus dans les tumeurs solides exprimant l’ACE, en consolidation apres chirurgie ou avec des systemes de preciblage.

Resume La radio-immunotherapie (RIT) est une forme de radiotherapie interne utilisant comme agent de vectorisation un anticorps monoclonal, reconnaissant un antigene exprime par les cellules tumorales, couple a un radionucleide. Developpee depuis plus de 20 ans, son efficacite est demontree en hematologie dans le traitement du lymphome B. L’anticorps monoclonal murin anti-CD20 marque a l’yttrium-90 (Zevalin ® ) peut etre utilise en routine clinique dans le traitement des lymphomes folliculaires CD20 positifs chez les adultes refractaires ou rechutant apres traitement par rituximab, conduisant a des taux de reponse de l’ordre de 70 a 80 % avec 20 a 30 % de reponse complete. L’efficacite de la RIT du lymphome est plus importante en premiere ligne therapeutique, en consolidation apres un traitement par chimio-immunotherapie ou dans le cadre de protocoles myeloablatifs. Des resultats interessants ont egalement ete obtenus dans les tumeurs solides exprimant l’ACE, en consolidation apres chirurgie ou avec des systemes de preciblage.

Resume But Evaluer prospectivement la tomoscintigraphie stenopeique (S-TEMP) comparativement aux procedures classiquement realisees [scintigraphies planaires 99mTc-pertechnetate/99mTc-MIBI, tomographie parallele (P-TEMP) et echographie], pour la localisation preoperatoire des lesions parathyroidiennes (LP) dans l’hyperparathyroidie primaire (HPTp). Patients et methodes Les donnees des 51 patients gueris apres chirurgie ont ete analysees. La S-TEMP etait reconstruite en utilisant un algorithme dedie OSEM. Apres analyse visuelle des scintigraphies, un indice de confiance diagnostique (ICD) prenant en compte l’intensite et la localisation des fixations suspectes etait attribue pour chaque procedure : 0 = negatif ; 1 = douteux ; 2 = moderement positif ; 3 = franchement positif. Resultats Cinquante-cinq lesions parathyroidiennes ont ete resequees. Les sensibilites de l’echographie, des planaires, de la P-TEMP et de la S-TEMP etaient respectivement de 51, 76, 82 et 87 %. Cinq glandes etaient uniquement detectees en S-TEMP. La combinaison de l’echographie, des planaires et de la S-TEMP donnait la meilleure sensibilite (94,5 %). L’ICD moyen des 55 lesions etait significativement plus eleve en S-TEMP qu’en P-TEMP et planaire (p Conclusion La S-TEMP augmente la sensibilite et l’ICD de la scintigraphie. La combinaison echographie/planaires/S-TEMP apparait la methode optimale pour la detection et la localisation des lesions parathyroidiennes.

Resume A propos d’une malade porteuse d’une tumeur carcinoide digestive avec metastases hepatiques, nous rapportons les differentes alternatives therapeutiques (actuelles et en cours d’evaluation), en soulignant l’interet de la radiotherapie metabolique par mIBG-I131 au sein de cet arsenal. En effet, pour cette pathologie au pronostic reserve, comme il est souligne dans la litterature, l’efficacite interessante de ce radiopharmaceutique a la fois sur les symptomes, la masse tumorale et la biochimie en fait une alternative trop souvent sous-utilisee. Les options therapeutiques etant multiples et non codifiees, nous proposons une strategie de prise en charge des tumeurs digestives carcinoides grâce a la mIBG-I131.

The objective of the present multicentric phase II study (MIITOP) was to determine the response rate, survival and toxicity of tandem infusions of 131I-meta-iodobenzylguanidine (mIBG) and topotecan in children with relapsed/refractory neuroblastoma. High-dose 131I-mIBG therapy programme requires a deal of planning, availability of hospital resources and the commitment of individuals with training and expertise in multiple disciplines. Here in the present study, procedures and the results of patient's dosimetry, as well as family and worker's exposures, were reported for the patients treated in Lille. A total of 15 children were treated with 131I-mIBG between 2009 and 2011 according to the MIITOP protocol. High activity of 131I-mIBG (444 MBq kg-1) was administered on Day 0. In vivo dosimetry was used to calculate a second activity, to be given on Day 21, to obtain a total whole body absorbed dose of 4 Gy. Family and worker's exposures were performed too. The injected activity by treatment was from 703 to 11470 MBq. Total whole body absorbed dose by patient ranged from 2.74 to 5.2 Gy. Concerning relatives, whole body exposure ranged from 0.018 to 2.8 mSv. The mean whole body exposure of the radiopharmacist was 4.4 nSv MBq-1, and the mean exposure of fingers ranged from 0.18 to 0.24 µSv MBq-1 according to each finger. The mean whole body exposure was 33.6 and 20.2 µSv d-1 per person, for night nurses and day nurses, respectively. Exposure of doctors was less than 5 µSv d-1. Under strict radiation protection precautions, this study shows the feasibility of high-activity 131I-mIBG therapy in France.

International audience; UNLABELLED: The prognosis of medullary thyroid carcinoma (MTC) varies from long- to short-term survival based on such prognostic factors as serum calcitonin and carcinoembryonic antigen (CEA) doubling times (DTs). This prospective phase II multicenter trial evaluated the efficacy and safety of anti-CEA pretargeted radioimmunotherapy (pRAIT) in rapidly progressing metastatic MTC patients and also how serum biomarker DTs correlate with clinical outcome. METHODS: From June 2004 to January 2008, 42 patients were treated with anti-CEA × anti-diethylenetriaminepentaacetic acid (DTPA) bispecific antibody (hMN-14 × m734) (40 mg/m(2)), followed by (131)I-di-DTPA-indium bivalent hapten (1.8 GBq/m(2)) 4-6 d later. RESULTS: The disease control rate (durable stabilization plus objective response) was 76.2%. Grade 3-4 hematologic toxicity was observed in 54.7% of patients and myelodysplastic syndrome in 2, including 1 heavily treated previously. After pRAIT, 21 of 37 assessed patients (56.7%) showed a significant impact on DT (≥100% increase of pre-pRAIT calcitonin or CEA DT or prolonged decrease of the biomarker concentration after pRAIT). Pre-pRAIT DT and post-pRAIT DT were significant independent predictors for overall survival (OS) from pRAIT (pre-pRAIT: hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.24-0.86; P = 0.016; and post-pRAIT: HR, 5.32; 95% CI, 1.63-17.36; P = 0.006) and OS from diagnosis (pre-pRAIT: HR, 0.21; 95% CI, 0.08-0.51; P = 0.001; and post-pRAIT: HR, 6.16; 95% CI, 1.81-20.98; P = 0.004). CONCLUSION: pRAIT showed antitumor activity, with manageable hematologic toxicity in progressive MTC. Increased biomarker DT after treatment correlated with increased OS.

International audience; Medullary thyroid cancer (MTC) patients with localized residual disease and/or distant metastases may survive for several years or rapidly progress and die of their disease. Thus, highly reliable prognostic factors are needed for an early distinction between high-risk patients who need to be treated and low-risk patients who warrant a watch-and-wait approach. Calcitonin doubling time is an independent predictor of survival, with a high predictive value in a population of patients who have not normalized their calcitonin, even after repeated surgery. Several imaging methods should be proposed for patients with abnormal residual calcitonin levels persisting after complete surgery: ultrasonography and computed tomography (CT) for neck exploration, and CT for chest, abdomen, and pelvis. Magnetic resonance imaging (MRI) appears to have an advantage over CT for the detection of liver metastases from endocrine tumors. Moreover, MRI appears to be a sensitive imaging technique for detecting the spread of MTC to bone/bone marrow. 2-Fluoro-2-deoxy-D-glucose positron emission tomography/CT could be used for staging patients with progressive MTC, with possible prognostication by standard uptake value quantification. For systemic treatment of patients with rapidly progressing metastatic MTC, chemotherapy is not considered a valid therapeutic option. It is too early to evaluate the potential effectiveness of multikinase inhibitors, although interesting results of phase 2 studies have shown a transient stabilization in 30% to 50% of patients. Pretargeted radioimmunotherapy has been the only innovative treatment modality convincingly showing some survival benefit when compared with a historical untreated control group.

BACKGROUND: Significant antitumor effects were previously observed with radioimmunotherapy (RIT) using an anti-carcinoembryonic antigen (CEA) monoclonal antibody (F6) labeled with iodine-131 in medullary thyroid cancer (MTC)-bearing nude mice. Nevertheless, no complete response was achieved. Because angiogenesis is critical for tumor growth, bevacizumab is used to treat solid tumor in clinical practice. The present pilot study evaluated toxicity and efficacy of RIT combined with bevacizumab in mice subcutaneously grafted with TT MTC cells. METHODS: Groups of 4-6 nude mice were treated with 5 μg/g bevacizumab twice weekly during 4 weeks and/or 100 MBq of 131I-F6. For combined therapy, bevacizumab was given at Day 0 followed by 131I-F6 at Day 30. The control group received no treatment. Animal weight, hematological toxicity, tumor volume, and serum calcitonin were monitored for 2 or 4 months. RESULTS: Bevacizumab alone induced no cytopenia and no significant weight loss. A weight loss of 12 ± 1% and 15 ± 2% was observed in mice treated by RIT alone or bevacizumab + RIT, respectively. RIT alone and combined treatment induced leukopenia and anemia. RIT alone and RIT plus bevacizumab induced tumor responses with minimum relative tumor volume of 0.38 ± 0.24 and 0.15 ± 0.07%, respectively, and time to progression of 35 ± 5 and 56 ± 11 days, respectively. CONCLUSIONS: Pretreatment with bevacizumab improved RIT efficacy, with similar toxicity as compared as RIT alone. Cancer 2010;116(4 suppl):1053–8. © 2010 American Cancer Society.

Patients with progressive medullary thyroid carcinoma (MTC) undergo multiple imaging procedures for diagnosis of relapse and staging.Our objective was to assess the sensitivity and prognostic value of 18F-2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/computed tomography (CT), and the imaging sensitivity of pretargeted iodine-131-radioimmunotherapy (RIT) in patients with progressive MTC.We performed a prospective multicenter study in high-risk patients with rapidly progressing MTC enrolled in a phase-II pretargeted RIT study, as documented by short serum calcitonin (Ct) or carcinoembryonic antigen (CEA) doubling time (DT). INTERVENTIONS/MAIN OUTCOME MEASURES: Patients underwent neck-thoracic-abdominal CT, spine and pelvic magnetic resonance imaging, whole-body post-RIT immunoscintigraphy (IS) with iodine-131, and whole-body 18F-FDG-PET/CT imaging. Imaging sensitivity and the correlation between FDG uptake and biomarkers DT were evaluated.A total of 33 patients with mean CEA and Ct DTs of 1.90 yr (range 0.21-8.50) and 1.52 yr (range 0.09-6.01), respectively, were evaluated. Sensitivity of FDG-PET/CT was 83% for neck, 85% for mediastinal, 75% for lung, 60% for liver, and 67% for bone metastases; overall sensitivity was 76%. Median standardized uptake value (SUVmax) was 5.23 (2.06-13.90). SUVmax correlated significantly with Ct DT (P = 0.011) and minimal DT (minimal value between CEA DT and Ct DT) (P = 0.027). Overall sensitivity of post-RIT IS, CT, and bone magnetic resonance imaging were 94, 74, and 85%, respectively.These results demonstrate the value of FDG-PET/CT for staging of patients with progressive MTC, especially in the neck and mediastinum, with possible prognostication by SUV quantification. Post-RIT IS was the most sensitive of the imaging modalities studied prospectively.

Early therapy response assessment with metabolic imaging is potentially useful to determine prognosis in aggressive lymphoma and, thus, can guide first-line therapy. Forty-eight patients with aggressive lymphoma [24 Hodgkin's disease (HD); 24 non-Hodgkin's lymphoma (NHL)] underwent fluoro-deoxyglucose positron emission tomography (FDG-PET) before chemotherapy (PET1) and at mid-treatment (PET2). Therapeutic response was evaluated using conventional methods at mid-treatment. PET2 results were related to event-free survival (EFS) and overall survival (OS) using Kaplan-Meier analyses. PET1 was positive in all patients. PET2 was negative in 38 patients (18 NHL-20 HD) and positive in 10 (6 NHL-4 HD). Of the PET-negative patients, 61 and 65% achieved complete remission, and only 50 and 25% of PET-positive patients, respectively, for NHL and HD, achieved complete remission. Significant associations were found between PET2 and EFS (p = 0.0006) and OS (p = 0.04) for NHL, and EFS (p0.0001) for HD (but not for OS, because no HD patient died). FDG-PET at mid-treatment can predict the outcome of patients with aggressive lymphoma and should be a useful tool to modify an ineffective therapy.

We report different treatment options (currently used and on trial) for a patient with a gastrointestinal carcinoid tumor and metastases in the liver, and discuss the advantages of using internal radiotherapy with 131I-MIBG rather than other treatments. According to the literature, this pathology has a poor prognosis, and considering the significant efficacy of this radiopharmaceutical treatment on symptoms, tumor reduction, and biochemical parameters, it seems to be under used. There are currently no standard treatment options. We present a management strategy for gastrointestinal carcinoid tumors with 131I-MIBG.

10029 Background: Harmonised evaluation standards of MIBG scintigraphy for (re)staging of neuroblastoma (NB) are an international aim. In the HR-NBL1/SIOPEN trial population a SIOPEN score (SISCO) ...

The purpose of this study was to assess the rate of gastric emptying (GE) in cystic fibrosis patients scheduled for lung transplantation.Thirty patients (20 males, 10 females, 22.6 +/- 6.4 years) were evaluated by GE scintigraphy before (1.58 +/- 1.11 years) and early after (5.8 +/- 2.6 weeks) heart-lung transplantation (n = 13) or lung transplantation (n = 17). Solid retention rates at 2 hours (RR2) and 3 hours (RR3) and half-emptying times (T50) of solids and liquids obtained before transplantation were compared with those after transplantation. Data were also compared with those obtained from a control group of 53 healthy volunteers.Before surgery, 20 patients (67%) showed a delayed GE (T50 of solids: patients 160.86 +/- 59.21 minutes vs controls 75.43 +/- 15.13 minutes, p0.0001), and 4 of them also had a delayed T50 of liquids. After surgery, the T50 of solids was considered unreliable (too much stasis) in 24 patients. Thus, analyses were done on the basis of solid retention rates. Twenty-nine patients (97%) showed very delayed GE compared with controls (p0.0001), 20 of whom also had a delayed T50 of liquids. RR2 and RR3 were significantly higher after surgery than before (RR2 = 86 +/- 17% and RR3 = 77 +/- 22% vs 50 +/- 24% and 27 +/- 24% after and before surgery, respectively, p0.0001). However, there was no correlation between pre- and post-transplantation scintigraphy results.Delayed GE of solids was a frequent abnormality in patients with end-stage cystic fibrosis, with a dramatic delay after surgery in almost all patients. These results emphasize the need for early management of such patients by dietary manipulation or prokinetic medications.